Acceptance and use of electronic medical records: An exploratory study of hospital physicians’ salient beliefs about HIT systems

Abstract

If a hospital keeps electronic medical records (EMRs), the underlying health information system is the primary repository and source of patient-related data for hospital physicians. Even though the benefits and improvements attained through health information technology (HIT) are widely acknowledged, EMR adoption rates are surprisingly low in German hospitals. Since there is no ‘pull’ to use EMR systems, we theorize that low penetration of EMR systems could be in part explained by physicians’ antipathy towards computerized medical records. In order to examine physicians’ salient beliefs about EMRs and EMR usage and to identify the processes that form them, we conducted a multi-case study in German hospitals, drawing on concepts from Social Cognitive Theory and the Unified Theory of Acceptance and Use of Technology (UTAUT) to elicit beliefs and structure our analysis. This study sheds light on different types of beliefs and the belief-forming process and their impact on HIT acceptance and use. Our findings indicate that HIT acceptance and use is not solely impacted by cognitive behavioural and environmental factors, as proposed by UTAUT, but also by personal factors such as self-efficacy and emotions. Furthermore, our study provides evidence of continuous reciprocal causation across behavioural, personal and environmental beliefs. The findings indicate that existing technology acceptance models need to be modified for the specific health-care context by adapting the range, meaning and scope of constructs.

Keywords:

• electronic medical record (EMR)
• HIT
• technology adoption research
• social cognitive theory (SCT)

Acknowledgements

The authors gratefully acknowledge the constructive feedback of the reviewers, which greatly improved the paper.

Notes

1 HIT comprises all technologies that deal with the storage, retrieval, sharing and use of health-related information, data and knowledge for communication and decision making (Brailer & Thompson, 2004). As such it refers to information processing and communication capabilities that support the delivery of patient care (Chaudhry et al, 2006). Examples of HIT systems include EMR and PACS.

2 Ward physicians are specialized in a certain field of medicine and have successfully completed their residency training, whereas assistant physicians have graduated with a final medical exam but not yet completed their residency training (Bundesministerium für Gesundheit, 2002).

3 A statement on ‘ethics and medicine’ of the German Medical Association recently identifies altruistic motives as key characteristics of the medical profession (Deutscher Ärztetag, 2004)